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General NPI Number Information
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NPI Number | 1780670307
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Entity Type | Individual
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Provider Name | DWAINE EDWARD VALENTINE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 460 RONA PKWY
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City | BROOKVILLE
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State | OH
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Zip | 45309-1118
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Country | US
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Telephone | 937-833-4411
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Fax | 937-833-2473
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Provider Business Mailing Address
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Address Line | 460 RONA PKWY P.O. BOX 159
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City | BROOKVILLE
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State | OH
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Zip | 45309-1118
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Country | US
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Telephone | 937-833-4411
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Fax | 937-833-2473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | OH14992
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License Number State | OH
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